The United States is standing on the edge of a massive demographic shift — one that will transform healthcare, the workforce, housing, and the economy for generations to come. By 2040, one in five Americans will be over the age of 65. This isn’t just a future problem — it’s happening now, and it’s changing the way we think about aging, care, and quality of life.
We’ve faced transformative moments like this before. After World War II, the baby boom triggered an unprecedented expansion of public education, suburban development, and employer-based healthcare. In the 1960s, we saw the creation of Medicare and Medicaid, safety nets that reshaped access to healthcare for older and low-income Americans. Today, we face a similar moment of reckoning. Will we redesign our aging policies and systems to reflect modern needs, or will we allow outdated structures to buckle under the pressure of demographic reality?
Aging is a national challenge, but solutions must be local
While the growing number of older adults is a national issue, the reality is that aging happens in communities — in homes, neighborhoods, workplaces, and healthcare settings that are often ill-equipped to meet changing needs. Addressing this shift will require coordination at every level: federal, state, and local governments must work together while also engaging businesses, nonprofits, and communities.
At the federal level, Medicare and Medicaid remain the dominant forces in funding long-term care. Recent efforts to expand home and community-based services (HCBS) in Medicaid, along with new reimbursement models in Medicare Advantage, are promising steps — but they need sustained funding, bipartisan commitment, and regulatory stability. Without a long-term strategy, states will struggle to meet the needs of an aging population.
States, recognizing that aging policy isn’t just about healthcare, but about infrastructure, workforce, and economic stability, are taking matters into their own hands. New York, California, and Massachusetts have developed Master Plans for Aging (MPAs), which take a broad approach — integrating healthcare, workforce policies, housing, and transportation into a comprehensive vision for aging. These efforts are setting the stage for what aging policy could look like nationwide.
But while federal and state policies create frameworks, true change happens at the local level. Cities and towns are where housing accessibility, transportation networks, caregiver support, and social engagement programs either succeed or fail. Local governments, community organizations, and businesses need to be at the table — developing services that fit the realities of the people they serve. No amount of federal funding can solve the problem if the services on the ground don’t meet real community needs.
What we can learn from other countries
While the U.S. is still working through its approach to aging, other nations have already tested and implemented models that could serve as inspiration.
Japan, facing one of the world’s oldest populations, has embraced technology and intergenerational housing. Robots assist caregivers in long-term care facilities, while mixed-age housing developments are designed to reduce isolation and foster community engagement.
Scandinavian countries have prioritized aging-friendly infrastructure and preventive healthcare, ensuring that older adults have accessible housing and integrated social services that reduce the need for institutional care.
Germany has taken a different approach, offering long-term care insurance that provides universal coverage for aging-related services. This model blends public funding with private innovation, ensuring that long-term care needs don’t become an overwhelming financial burden for families.
The U.S. does not need to copy any one model outright, but we should look closely at these approaches—particularly at how other nations fund services, integrate technology, and create sustainable models of long-term care.
Aging is not just a government issue — it’s everyone’s issue
It’s a mistake to assume that aging is a problem for government to solve alone. Businesses, philanthropy, and local communities all play essential roles in shaping a future where older adults can thrive.
The private sector has already begun innovating in home care technology, financial planning for longevity, and workplace policies that accommodate older workers and caregivers. Employers need to rethink retirement policies, create flexible work arrangements for older employees, and provide support for family caregivers, who make up a growing share of the workforce.
Philanthropy and nonprofits are also stepping up, filling gaps where government programs fall short. These organizations test new models of care, fund aging-in-place programs, and advocate for policies that reflect the real needs of older Americans.
And at the most fundamental level, communities themselves must be engaged. Aging should not happen in isolation. Faith-based organizations, neighborhood groups, and volunteer networks can all play a role in ensuring that older adults stay connected and supported.
The time to act is now
Aging is not a crisis — it’s an evolution. It is a transformation that, if handled well, can create a society that values experience, supports independence, and builds systems that benefit future generations. But if ignored, it will strain public resources, deepen workforce shortages, and create a fragmented and inequitable system that fails millions.
We know what needs to be done. States must continue developing Master Plans for Aging and investing in community-based services, workforce development, and housing solutions. Federal policymakers must support these efforts with sustained Medicaid funding, expanded HCBS options, and workforce incentives for caregivers. The private sector must build aging-friendly workplaces and drive innovation in home care and financial planning.
This is not just about today’s older adults — it’s about the next 50 years. If we design a smarter, more sustainable system now, we will all benefit when our time comes.
The moment to act is now. The future of aging in America is being written today. What we choose to do next will define the health, security, and dignity of millions of people for generations to come.
Photo: izusek, Getty Images
Adam S. Herbst is a healthcare partner at Sheppard Mullin in New York, advising government agencies, hospitals, health systems, post-acute care providers, and private equity firms on healthcare policy, regulation, and strategy. He specializes in reimbursement reform, regulatory compliance, value-based care, and healthcare innovation. Previously, Adam served as Deputy Commissioner at the New York State Department of Health and Special Advisor to two New York Governors, shaping policies for one of the nation’s largest healthcare systems. He led initiatives modernizing care for aging and disabled populations, overseeing hospitals, nursing homes, home-based services, and Medicaid programs.
An adjunct professor of Health Law and Bioethics, Adam is a recognized thought leader, frequently speaking and writing on healthcare access, Medicaid policy, and regulatory trends. His expertise helps clients navigate emerging care models, Medicaid transformation, and strategic initiatives that bridge policy and practice.
This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.